Best Practices in Electronic Health Records - Essay Example

The electronic health records (EHR) is increasingly being used within health care organizations but this poses several challenges. These have to be used by clinicians and hence the user characteristics and technical training are important factors for the success of the implementation of EHR (Poissant, Pereira, Tamblyn & Kawasumi, 2005). The initial planning itself has to take care of the integration of the EHF intro the clinical workflow. The order entry systems and the automated reports should be supported by technical functions like speed and accuracy. The expertise in clinical functions and the time efficiency are relevant factors that lead to the fit between the requirements and the system. EHR requires heavy investments and not all health care organizations can afford this expenditure. Hence it becomes necessary to understand the trade-off between the investment in EHR and maintaining paper records. This has been studied through an investigation into the practices of one health service provider that uses EHR and another that continues with paper records – namely – Mercy Medical Center and Advocate Health Center. The study was conducted by way of interviews (Appendix A) and a summary of the findings is presented below. Since clinicians spend the majority of their time in providing direct care to the patients, maintaining EHR could increase the patient-clinician interaction time which in turn enhances the quality of care delivered (Poissant et al). This was confirmed by Jeanne Sosnicki- Manager of HIM records at Mercy Medical Center (MMC) when she stated the numerous benefits that their organization had achieved in the short span of time. MMC have started the EHR only in September 2008 but can find several tangible benefits from the system. Time efficiency is one of the major benefits that this health care organization has been able to achieve. The manager at MMC believes that the system has improved access to medical record information which has in turn improved the work flow at the organization. This is because the EHRs are available to multiple users 24x7 and hence decision-making has improved. Besides, it is now possible to edit the EHRs by appropriate authorities. Besides, it has become very convenient to access records real time at any time of the day and night. It is also easier to update and maintain records. The old handwritten charts could be looked into by only one person at a time (Reiter, 2009) where as the EHR can be accessed by multiple users at the same time and it also allows for quicker retrieval. Apart from increased access by clinicians and the other users, labs, radiology reports, orders, physician notes, consults, surgical information, etc. is available in real time. This is considered a major benefit in service delivery as it enhances the delivery process while reducing the time both for the patient and the care giver. The other tangible benefit that MMC has achieved in by way of reducing the space required to store the paper records. This took a lot of space and now this space is freed which can be put to better use. They had three different storage areas for charts but with EHR they can just have one long-term storage site (Reiter, 2009). Although the EHRs are available to multiple users within the organization, many physicians do not have appropriate computer access. This delays the transmission of diagnostic reports to the physicians because they continue to receive the diagnostic results via fax. Physicians generally oppose change but as far as this is concerned, they have liked the change over to electronic format (Reiter, 2009). The physicians too are not yet able to prescribe electronically because the system is yet to be effective to that extent. While the facility has been incorporated, it is not yet implemented. The system at MMC is still not fully electronic because even the patients have to come physically to HIM to sign a release form and collect a printout of the EHR. Once fully operational the doctors can log in from their own office which saves them a trip. The MPI is the most important resource at the healthcare facility but at MMC the MPI is still entered and maintained by their McKesson Star system. This transition has not yet taken place. MMC continues to use paper which suggests that their entire system is not well integrated with the clinical workflow. They do not have the facility to capture the digital signatures which requires the patient to be physically present to sign on the paper which is then scanned into the EHR. Apart from this, there are several other forms that are in paper format and have to be scanned and added to the EHR. Besides, they require printouts of several mails and faxes that serve as important documents. Hence they have not been able to completely do away with paper records. However, the manager did admit that even though they need to maintain paper records, it is simply because the system is not well integrated and not because the paper records are better than electronic records. One major drawback when anyone can access the medical records is that the data can be misused as in the case of Farrah Fawcett whose medical records from UCLA were leaked to tabloids (Reiter, 2009). This was a violation of the federal medical privacy laws and the criminal is liable to be fined and jailed. Thus the starting of the EHR has basically benefited the organization as such in access of the data as well as being able to access the diagnostic reports in real time. This benefit is yet to be achieved to the benefit of the physicians and the patients. Both physicians and patients have to deal with paper format and once this too is implemented, the benefits would multiply thereby enhancing the service delivery process. The benefits that HIM has derived is clearly evident when the Administrative Supervisor, Yolanda Young, of Advocate Medical Group-Evergreen Pediatrics (AMG), confessed that charts are often misfiled and precious time is lost in locating such files. Time efficiency is the most important factor and this is lost due to human errors. AMG does have a chart tracking database system to log out the chart required but sometimes the system does not work and hence manual retrieval becomes necessary resulting in loss of time. Both these reasons – inappropriate filing and breakdown of the system lead to loss of time and efficiency in the organization. Another human error that occurs at AMG is that the chart may carry an incorrect number which makes it difficult to locate the chart. Although this is not a common occurrence, when it does happen, it can delay the process even by months. This is where EHR scores over the paper format for storing health records of patients. AMG uses the Problem-Oriented health record format, in which the physician documents and defines each clinical problem individually, such as the problem list, initial plans, the database and progress notes. Because of the numerous delays and problems faced by them, AMG is transitioning to the electronic format but the process is very slow. Besides, they do not expect that electronic health record system would be fully integrated into their system as they receive test results and consultation notes from other facilities that will not have access to their EHR system. This information will have to be manually scanned and transferred into their EHR system. Many forms such as consent forms, privacy notices, authorizations, discharge instructions and hence paper work cannot be eliminated altogether. This is the problem that HIM also faces because forms have to be manually signed in original. AMG is however trying to decrease the paper work as much as possible. The executive at AMG does understand the significance of going electronic and recognizes that the system has to fit the needs of the organization. For instance, any health care organization has to comply with the requirements placed on them by insurance companies, state and federal statutes. Even now the organization takes pride in its service care and in its commitment to development and they feel that with EHR would only enhance the process and their commitment to excellence. For instance, they expect that prescription refills would be easier and it would be possible to maintain a record of the prescription. The benefits that are being appreciated by HIM have been cited as expected benefits by AMG. Real time availability of medical resources would assist the physician in coding and patient care. AMG has installed the ScanPlus-Vista scanners at every station with medical records and anywhere that charts need to be checked in (Intermec, 2000). They have 3400 printers at the medical records department. They also provide training in handling the equipment. This system has virtually reduced the margin of error to virtually zero. This system has helped them to improve their service delivery because if the doctor knows where the chart is, it saves the waiting time for the patient. Before they started this system they had to pull out the patient records three days ahead of appointment but that has significantly been reduced. They now expect that when the system goes electronic, the efficiency will further improve. Most health care organizations have sat up as Barack Obama has announced that all medical records have to be electronic by the year 2013 (Reiter, 2009). This is the future of the health care industry but because of the huge investments many were discouraged. However, with the announcement of the new stimulus package there is real enthusiasm to adopt the EHR. A structural approach has been embodied in the American Recovery and Reinvestment Act of 2009 (ARRA), which sends a clear and powerful message to all the health care providers country wide (Acius, 2009). Enough evidence is available to suggest that EHR can prevent medical mistakes, reduce costs, save time, improve efficiency and the quality of clinical decisions, eliminate errors and enhance customer retention, and hence this step should be taken as fast as possible. A study of two different organizations – one using the electronic format for maintaining health records and the other still using the paper based records - reveals that the EHR does have tangible benefits in various ways. However, both the organizations feel that paper records cannot be totally done away with. They still need to take the patient’s consent manually as even HIM is not prepared for digital signatures. The only drawback in EHR is that anyone can access the medical records of the patient and play with it or sell it or misuse it. Even though there are laws to handle the situation but the damage is already done by that time. Despite this drawback, heath care organizations have to switch over to electronic format because of the other benefits and because the new President is making it mandatory that by 2013 all health care organizations have to go electronic. AMG, to some extent has been trying to use the scanner to eliminate the time taken to find a chart or patient record but human error cannot be overlooked. They are facing problems even when the physician has to manually go through the diagnostic results and prescribe for the patient but this problem also persists in HIM despite the EHR. Even with electronic format, the physicians are yet unable to prescribe electronically. Hence even at Him the full potential of electronic format has not been utilized. It has only eased the tracing of records and the facility that multiple users can access data at the same time, any time but the benefit has not been passed on to the patients and the physicians at this time. AMG realizes the problems in maintaining paper records and are trying to switch over to electronic format as soon as possible. Both however contend that some paper forms would still be required. This implies that total electronic format is not possible – or perhaps it would be possible by integrating technology with the system. Digital signatures can be captured and if patients are allowed to make appointments online and submit their consent forms online, things would be further eased. All efforts are geared towards reducing costs, reducing wait time, enhancing productivity, and ultimately the service delivery process. References Acius, 2009, Best Practices in Electronic Health Records, retrieved online June 5, 2009 from http://www.acius.net/wiki.aspx/fs/conferences/pdf/122_akinBostonelectronicHealthhighlight5-7.pdf Internec, 2007, Advocate Health Center, retrieved online June 5, 2009 from http://epsfiles.intermec.com/eps_files/eps_cs/AdvocateCaseStudyWeb.pdf Poissant, L Pereira, J Tamblyn, R & Kawasumi, Y 2005, The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic Review. Journal of the American Medical Informatics Association, vol. 12, no. 5, pp. 505-516 Reiter, C 2009, Hospital records at Mercy Medical Center going, retrieved online June 5, 2009 from http://www.emrspecialists.com/2009/05/hospital-records-mercy-medical-center-digital/ Appendix A Electronic VS. Paper-Based 1. How long has the electronic version in the HIM department at Mercy Medical been established? 2. What are the benefits of having Electronic Health Records? 3. I know the MPI (Master-Patient Index) may be considered the most important resource in a healthcare facility. Do you find it easier maintaining the MPI by using the electronic format? Or is it used at all? 4. Do you find the EHR system easier to access information quickly and easily? 5. Do you find the EHR easier maintaining and updating records? 6. Do you find the delivery of diagnostic test results to the physician and patient much faster through electronic transmission? 7. Does your EHR system have the feature of electronic prescribing? which transmits prescriptions directly to the pharmacy 8. Do you still use some for of paper? And if so, why? 9. Can you think of any instances in which paper medical records would be preferred over electronic records? Read More